Effectiveness of the implementation of a central venous catheter management program on the rate of bacteremia in hemodialysis
DOI:
https://doi.org/10.60108/ce.374Keywords:
Bacteremia, Care (Desh), Central Venous Catheter, Hemodialysis (Desh), Nurse (Desh)Abstract
Bacteremia related to tunnelled central venous catheters for hemodialysis is associated with high morbidity and mortality. In Spanish units, the rate varies between 0.24 and 5.47 events per 1,000 catheter-days; this wide range reflects significant differences in clinical practice. According to Clinical Guidelines, a rate below 1 bacteremia per 1,000 catheter-days is considered excellent. The objective of this study is to analyze the influence on the bacteremia rate of a CVC management program during hemodialysis connection and disconnection (Bacteremia Zero Program).
Using an analytical, observational, and retrospective approach, bacteremia rates were compared in the two years prior to the program implementation (2019 and 2020) with the two subsequent years (2021 and 2022). One hundred thirty tunnelled catheters in 102 patients were evaluated, revealing a significant reduction in the bacteremia rate from 1.62/1000 catheter-days before the program to 0.53/1000 catheter-days after its implementation.
The establishment of the "Bacteremia Zero" program proved to be effective in reducing the bacteremia rate, approaching the excellence standards outlined in Clinical Guidelines. However, the study suggests the need to explore additional measures to achieve rates closer to the aspiration of "zero bacteremia."
References
1. Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004; 44:779.
2. Beathard GA. Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol. 1999 ;10: 1045-9.
3. Stevenson KB, Hannah EL, Lowder CA, Adcox MJ, Davidson RL, Mallea MC, et al Epidemiology of hemodialysis vascular access infection from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis. 2002 ;39: 549-55.
4. Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S. Incidence of bloodstream infection in multicenter infection cohorts of hemodialysis patients. Canadian Nosocomial Infection Surveillance Program, Canadian Hospital Epidemiology Committee. Am J Infect Control. 2004; 32:155.
5. Weijmer MC, Vervloet MG, Ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant. 2004;19: 670-7.
6. Albalate M, Perez R, De Sequera P, Alcázar R, Puerta M, Ortega M, et al. ¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéter para HD? Nefrología.2010;3:573-7.
7. Arribas P. Prevalencia de bacteriemias relacionadas con el catéter de hemodiálisis en una unidad hospitalaria. Enferm Nefrol.2013;16:229-34.
8. Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO. Tunnelled haemodialysis catheter bacteraemia: Risk factors for bacteraemia recurrence, infectious complications and mortality. 2006. Nephrol Dial Transplant. 2006;21: 1024–35.
9. García P, Payá E, Olivares R, Cotera A, Rodríguez J, Sanz M. Diagnóstico de las infecciones asociadas a catéteres vasculares centrales. Rev Chil Infect. 2003; 20 (1): 41- 50.
10. Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int.1999; 55:1081- 90.
11. Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int .2011; 79, 587– 98.
12. Vijayan A, Boyce JM. 100% de uso de procedimientos de control de infecciones en instalaciones de hemodiálisis. CJASN.2018,13 (4) 671-3.
13. Aguinada A, Del Pozo JL. Infección asociada a catéter en hemodiálisis: diagnóstico, tratamiento y prevención. NefroPlus. 2011; 4(2):1-10.
14. Silva T, De Marchi D, Mendes ML, Barretti P, Ponce D. Approach to prophylactic measures for central venous catheter-related infections in hemodialysis: A critical review. Hemodialysis International. 2014; 18:15–23.
15. D´Agata EMC, Mount DB, Thayer V, Schaffner W. Hospital-acquired infections among chronic hemodialisys patients. Am J Kidney Dis. 2000; 35(6):1038-8.
16. Miler LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M et al. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis. 2016;27;3.
17. Beathard GA, Urbanes A. Infection associated with tunneled hemodialysis catheters. Semin Dial. 2008;21(6):528-38.
18. NFK/DOQI. Clinical Practice Guidelines for Vascular Access. Am J Kidney Dis. 2006;48 (Suppl 1):S176-273.
19. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias. Grupo de Trabajo de Enfermedades Infecciosas. Agencia de Calidad. Ministerio de Sanidad, Seguridad Social e Igualdad [Internet]. Proyecto Bacteriemia Zero [Consultado 7 de Agosto de 2023]. Disponible en: http:// www.msps.es/organizacion/sns/planCalidadSNS/bacteriemia.htm
20. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-realted bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-32.
21. Roca-Tey R, Samon R, Ibrik O, Roda A, González-Oliva JC, Martínez-Cercós R, et al. Incidence and etiology of vascular access (VA) thrombosis in prevalent patients under VA surveillance for stenosis by blood flow rate (QA) measurements. Nephrol Dial Transplant 2012;27(Suppl 2):257.
22. Centers for M, Medicaid Services HHS. Medicare Program; end stage renal disease prospective Payment system, Payment for renal dialysis Services Furnished to Individuals with Acute kidney Injury, and end-stage renal disease Quality Incentive Program. Final rule. Fed Regist 2017;82(210):50738-97.
23. Nicole AG, Tronchin DMR. Indicadores para avaliação do acesso vascular de usuários em hemodiálise. Rev Esc Enferm USP 2011;45(1):206-14.
24. Miler LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis.2016; 27:1-11.
25. Beathard GA, Urbanes A. Infection associated with tunneled hemodialysis catheters. Semin Dial 2008;21(6):528-38.
26. Palomar M, Álvarez-Lerma F, Riera A, Díaz MT, Torres F, Agra Y, et al. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med. 2013; 41 (10): 2364 - 2372. doi: 10.1097/CCM.0b013e3182923622.
27. Comunidad de Madrid [Internet]. Informe del Registro Madrileño de Pacientes Renales 2021[citado el 8 de agosto de 2023]. Disponible en: https://www.comunidad.madrid/sites/default/files/doc/sanidad/asis/informe_remer_2021.pdf
28. Sociedad Española de Nefrología [Internet]. La Enfermedad Renal Crónica en España 2022 [Citado el 8 de agosto de 2023]. Disponible en: https://www.seden.org/files/courses/Informe_390a.pdf
29. Fundación Renal Iñigo Álvarez de Toledo [Internet]. [Citado el 8 de agosto de 2023]. Disponible en: https://fundacionrenal.com/contenido/libros/memoria2019.
30. García P, Payá E, Olivares R, Cotera A, Rodríguez J, Sanz M. Diagnóstico de las infecciones asociadas a catéteres vasculares centrales. Rev Chil Infect 2003; 20(1): 41- 50.
31. Miler LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis 2016; 27:1-11.
32. Cárcamo Baena J, Salgueira Lazo M, Gómez Castilla C, Rodríguez Pérez MA, Tienda Moreno M, Rico Castillo C, et al. Modelo de manejo multidisciplinar de catéteres permanentes tunelizados: resultados a 5 años. Rev Soc Esp Enferm Nefrol 2012; 15(2):138-44.
Additional Files
Published
Issue
Section
License
En caso de que el artículo sea publicado, los autores aceptan transferir todos los derechos del trabajo presentado, incluidos los derechos de autor y aquellos relativos a la transmisión electrónica, exclusivamente a CODEM, de manera universal, en todos los idiomas, una vez que el trabajo haya sido aceptado para su publicación dentro de la revista electrónica CONOCIMIENTO ENFERMERO.
El autor podrá hacer copias ilimitadas del trabajo para uso docente, reutilizarlo en su totalidad o parcialmente en un libro escrito por el autor o hacer copias para su distribución en la institución en la que trabaja. CODEM hará mención al nombre del autor en las publicaciones que se realicen del trabajo.
